Monthly Premiums
| Plan Option* | Employee | Family | Employee + Spouse | Employee + Child(ren) |
|---|---|---|---|---|
| Plan 1 | $1011 | $3338 | $2022 | $1719 |
| Plan 2 | $910 | $3003 | $1820 | $1547 |
| Plan 3 | $701 | $2316 | $1403 | $1193 |
| Plan 4 | $696 | $2299 | $1393 | $1184 |
* To determine the deductible amounts, out-of-pocket maximums, and coinsurance percentages for each plan option, please consult the detailed chart below.
Rates effective for rate region K.
For COBRA members located in (1) Wisconsin except for the Jefferson metropolitan area, and (2) states outside Wisconsin:
- Estimated 2026 regional rating factor = +6.5%.
- Estimated 2027 regional rating factor = +5.1%.
For COBRA members located in the metropolitan area of Jefferson, Wisconsin:
- Estimated 2026 regional rating factor = (-6.6%).
- Estimated 2027 regional rating factor = (-5.1%).
Please see the 2026 rate announcement page for additional details regarding the 2026 rate changes.
| Plan | Plan 1 | Plan 2 | * Plan 3 | Plan 4 |
|---|---|---|---|---|
| Medical Deductible Individual | $500 | $1000 | $3400 | $3500 |
| Medical Deductible Family | $1000 | $2000 | $6800 | $7000 |
| Member Cost Share (Co-Insurance) for Covered Medical Expenses After Deductible | 10% In-Network 30% Non-Network | 15% In-Network 30% Non-Network | 20% In-Network 30% Non-Network | 20% In-Network 50% Non-Network |
| Medical Out-of-Pocket Maximum Individual | $1500 | $3000 | $5100 | $6000 |
| Medical Out-of-Pocket Maximum Family | $3000 | $6000 | $10200 | $12000 |
| Rx Out-of-Pocket Maximum Individual | $1000 | $1000 | Applied to Medical Deductible; then Plan pays 100% | $500 |
| Rx Out-of-Pocket Maximum Family | $2000 | $2000 | Applied to Medical Deductible; then Plan pays 100% | $1000 |
| Total Plan Out-of-Pocket Maximum Individual | $2500 | $4000 | $5100 | $6500 |
| Total Plan Out-of-Pocket Maximum Family | $5000 | $8000 | $10200 | $13000 |
* Please note: Plan 3 is a Health Savings Account (HSA)-compliant High Deductible Health Plan (HDHP). Benefits and coverage under Plan 3 may be different from other plan options. Please consult the Plan 3 Summary Plan Description for additional details or contact the Benefit Plans Office.